Using the Current Reality Tree

2 01 2010

One of the most useful tools I have in my “arsenal” is the Current Reality Tree. My favorite technique learned in my classes has been the 5 Y’s. I find it useful not only in business but also in my personal life. For those reading who are not familiar with the term it is basically asking at least 5 “why’s” for every problem you have until you get to the root cause of the problem, so for example if you’re car was not running the scheme would go something like:

Issue: My car won’t start

Why? Fuel is not getting to engine

Why? There is water in the fuel line

Why? The car is in the swimming pool

Why? The emergency brake malfunctioned

Root Cause and Solution: emergency brake needs to be repaired

It is a basic and simple technique but one that digs deeper and deeper until it hits the core of the issue. A way to illustrate this process is using a Current Reality Tree, which is a system tool that helps discover underlying issues, or root causes, that are sustaining the current system or practice which effects efforts to reach your desired future or process.

In starting, the basic question is always “Why is there a difference between the desired future and the current reality?” so to begin with, the action team needs to agree on a couple of points; the desired future, and what the current situation is. This can cause issues with team members, especially if one of the issues is something they are responsible for, so determining a good, open-minded, cross-sectional team is paramount to the success of the venture.

There are 10 steps in creating a CRT as described in most literature on the subject.

Step 1:

Identifying the action team is the first step. The team must be diverse and should have intuitive knowledge about the current situation and methodology and can recognize and understand the deeper patterns and interactions in the system.

Step 2:

Identify the problem being asked. The problem must be:





Have no existing solution

Provides a learning opportunity

In addition, the action team must have authority for solutions AND action. This is usually the stumbling block. Identifying the problems and potential solutions means nothing, and is a waste of staff time and effort, if there is no buy in from senior management.

Step 3:

Identify the KEY QUESTION. The ALWAYS begins with a WHY.

Step 4:

Create a list of Undesirable Effects (UDE’s). They are called UDE’s because they are negative/bad (Undesirable) and because the effects are usually caused by something else.

Refer to the Current Situation and make a list of “reasons/answers” to the key question. This is where open-mindedness comes into play. You must allow staff to identify issues with themselves and each other to garner clear points.

  1. This will involve the practices, values, and resources identified in the household (work group), community (business), and government levels.
  2. These will more than likely be negative and related to the gap between vision and reality.

Step 5:

Connect UDE’s in a logical order of “cause” and “effect”. Each UDE should be considered as both a statement and a pointer to a deeper question. The task of the action team is to make these connections until a root cause is identified.

  1. Write each UDE on a sticky note or index card.
  2. Identify the relationships
  3. Decide if one UDE may be the cause of another
  4. Arrange vertically so that the root cause is on the bottom

Step 6:

Identify intervening steps that may be a part of the original pair. Ask yourself if the UDE is a true cause of the effect or are there steps between that are missing. This missing steps could be UDE’s already identified, a new UDE which needs to be added, or a UDE that is out of sequence.

Step 7:

Repeat this process with all UDE’s from the original group. Connect all possible UDE’s together and look for multiple causes of a single UDE.

Step 8:

Review and trace the cause and effect chain deeper within each branch until an end point is reached. This would be the root cause. At each UDE the question is “why does this exist?

The answer is the next lowest UDE.

Step 9:

Prune the CRT, making sure all UDE’s have been used and delete (or prune) from the tree any that are not required to connect all of them. Also look for unrelated UDE’s, or “facts of life”.

Step 10:

Identify root causes and the core problem by locating all of the potential root causes (i.e. arrows going out of but none coming in). Any root cause that accounts for 70% or more of the UDE’s is considered the Core Problem.


Working From Home Increases Productivity

2 01 2010

When starting my current position one of the biggest challenges was what staff referred to as the “amnesty list”. In basic terms, this was a list of patients that were so out of date that the center was granted more time to address entry of informatics on these patients into the new national system. With the new systems and forms coming online in January 2008 the number placed in amnesty was 1,622. This was the total number of patients, not forms. If you included forms it reached well over 12,000 with multiple data points within each.

This was a daunting task by anyone’s account, but made even more problematic by the staffing level of the team it was given to. Not only were they tasked with completing work on the amnesty list, they also had current patient information to abstract and enter into not one, but two database systems (this was due to the national database not being able to link to the internal Center database).

In January 2008, when the forms went into place, there were 1,622 patients on the amnesty list and no real plan to meet this challenge.

In January 2008 the total number of forms entered into the system was 4 and the total patients removed from the amnesty list were 0.

After assuming the supervisor position it was one of my first jobs to address the situation. The roadblocks at that point were:

· Staff were sharing an office (3 in one and 1 in a cubicle)

· The office space was not big enough

· The office space allowed no privacy

· The job requirement was not outlined to the staff

· No plan of action was developed

· No expectations were written down

In the process of taking over we lost one staff to another division. We replaced her with a senior staff member from an outside agency, and also added a lower data entry staff person with the idea of training her into the position. The staff was set in April of 2008, after I assumed the role in March 2008.

In meeting the data entry needs I realized that whatever we had been doing in the past was not working so we needed to think outside the normal work process in order to meet this need. I had read a few articles on telecommuting and how it had worked in companies like Microsoft, AT&T, and the like, but the Center was not set up to work like this. After talking to my staff to get their input, we decided to try it on a trial, 90-day test run to see what we could show.

In May of 2008 there were 127 forms entered into the National database, a definite increase from the beginning of the year. When we went to telecommuting this number increased to 387 in one month and has since averaged in the 250 per month range. In the year prior the amnesty list had remained at 1,622 because everyone was working on fires and no one was tasked to face this assignment. We took the data entry staff we had hired and tasked her directly with the amnesty list in October of 2008. Since that time the list has gone from 1,622 to 575 (as of June 2009) with a projected completion date of October 22, 2009.

Measured productivity (in this case the number of forms submitted with NO errors) went from 80% to 116% in the 9 months since moving to a home based work environment. We can attribute this to a few items:

· Staff is not confined to a small work space

· Staff is allowed the freedom to work as they wish for 8 hours per day

· Staff morale is boosted by giving them autonomy in their work day planning

· Staff is given ownership of their numbers

· Staff is on their own, so “visiting” with other staff, and interruptions during the work day is minimized

Staff is required to work one day per week in the office due to required reviews with medical staff on issues that necessitate face to face meetings. Also, there is an all hands data staff meeting on the last Friday of the month to go over issues that have arisen, quality assurance, and team building.

It’s still a work in progress, and a few kinks have shown their head at certain points, mostly when a data need is required, but it is much better than it was. Ongoing effort in standard operating procedures for data entry and quality assurance is in the works.